Medicine involves decisions. But for Medicare patients with conditions for which surgery is an option, whether they undergo elective surgery depends largely on where they live and the clinicians they see. Research suggests that for many conditions -- especially those that can be treated with elective surgery -- the treatment a patient receives depends more on the physician's recommendations than the patient's preferences. When studying elective surgeries, the Dartmouth Atlas found remarkable variation in these "preference-sensitive" procedures for Medicare patients, even though they had similar conditions. This series, a collaborative project with the Informed Medical Decisions Foundation, looks at the variation in surgical rates in 306 hospital referral regions across the United States. Each report highlights one of nine regions and shows the variation that exists even across these smaller geographic areas. To download data for all regions, please visit our Downloads page.

This report, supported by The John A. Hartford Foundation, explores the care experienced by older adults in the U.S., including the number and types of care providers they see, along with the frequency with which they have contact with the health care system. It identifies areas where improvements are most needed and recognizes areas in which improvements are already under way. Finally, it notes the distinctive challenges and opportunities presented by people with multiple chronic conditions and dementia. Read the report, policy-oriented or consumer-oriented press release, download data tables, or purchase a copy.

A casual reader of The New York Times article by Kevin Quealy and Margot Sanger-Katz, "The Experts Were Wrong about the Best Places for Better and Cheaper Health Care," would be forgiven if they missed this critical point. By focusing only on total spending—price times quantity—they give the impression that Medicare data tells us nothing about private insurance markets. Not so.

The Dartmouth Atlas of Health Care is based at The Dartmouth Institute for Health
Policy and Clinical Practice and is supported by a coalition of funders led by the Robert Wood Johnson Foundation,
including the WellPoint Foundation, the United Health Foundation, the California HealthCare Foundation, and the Charles H. Hood Foundation.